Specific carbohydrate diets, even modified, improve pediatric IBD symptoms
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Pediatric patients adhering to a specific carbohydrate diet or modified specific carbohydrate diet showed improved symptoms of their inflammatory bowel disease, according to a presentation at Crohn’s and Colitis Congress.
“We took a unique way of investigating diet ... something called n-of-1 trials, which has significant benefit for looking at diet in conditions such as IBD. With n-of-1 trials, it’s a single subject experimental design where the patient serves as their own control and treatment is systemically varied over time,” David Suskind, MD, said during his presentation of the PRODUCE study. “We used a series of n-of-1 trials to determine the effectiveness of the specific carbohydrate diet [SCD] in reducing symptoms and inflammation in patients with IBD as compared to a modified SCD as well as their usual diet. The advantage to n-of-1 trials is that it gives not only information for the individual but, when aggregated, population level information.”
Suskind presented data from this study, which is based on “n-of-1” individual studies in patients aged 7 to 18 years. He explained in this format, each patient serves as their own control, moving from their baseline diet for 4 weeks to either the specific carbohydrate diet (SCD) for 8 weeks or to a modified SCD for 8 weeks. They then rotated every 8 weeks to the alternative study diet. The aim of the study spanned 32 weeks, throughout which the researchers measured stool frequency and consistency, GI symptoms, disease activity and fecal calprotectin as a measure of inflammation.
Suskind noted that 20% entered the study in clinical remission but with elevated inflammatory markers; 40% came in with mild disease and 20% came in with moderate disease.
Of the 54 patients enrolled, just 21 patients (39%) completed the full 32-week study with two crossovers to the two diets. Nine (9%) completed the study early or completed just one crossover and 24 (44%) withdrew from the study, “indicating it can be difficult to follow dietary regimes,” Suskind said.
“Among full completers of n-of-1 trials, there was a very high probability of improvement in GI symptoms and pain interference measures,” Suskind said.
He showed both diets improved GI symptoms as well as pain, with no significant difference between the two.
“There’s also a reduction in fecal calprotectin in the SCD and MSCD in comparison to their baseline diet,” Suskind said. “There was also a low probability that SCD was better than the MSCD, on average.”
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Suskind D. Holistic View of IBD: Diet, Disparities and Well-Being. Presented at: Crohn’s and Colitis Congress; January 21-24, 2020.
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